Effectiveness of a transdiagnostic computerized self-applied program targeting children with emotional problems: A randomized controlled trial.

BACKGROUND: Super Skills for Life (SSL) is an eight-session transdiagnostic program based on cognitive-behavioral therapy (CBT), aimed at the indicated prevention of childhood emotional problems, which has been implemented with positive short- and long-term results. The present study aimed to examine the effects of a self-applied computerized program based on SSL that maintains the same objectives and contents as the face-to-face program. METHODS: In this randomized controlled study, 75 children (49.3 % female) aged 8-12 years (Mage = 9.45, SD = 1.31), selected for exhibiting emotional symptoms, were randomly assigned to either the intervention (n = 35) or the waiting list control (WLC) group (n = 40). Pre- and post-intervention data were collected through self-reports and the report of parents who completed parallel versions of the same measures of emotional and behavioral problems. RESULTS: Overall, compared to the WLC group, the intervention group showed positive effects on targeted emotional symptomatology in the short term. Based on parents' reports, a significant reduction was found in outcomes such as anxiety, depression, emotional symptoms, and internalizing problems, while self-reported results were similar except for anxiety. In addition, a positive impact was found on symptoms related to other types of difficulties (e.g., externalizing problems and general difficulties measured). LIMITATIONS: Small sample size, non-inclusion of follow-up assessment and other informants (e.g., teachers). CONCLUSIONS: In conclusion, this research provides novel and promising data on the self-applied computerized adapted version of the SSL program, within a multi-informant approach, suggesting that it may be a useful tool for the indicated prevention of childhood emotional problems.

Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P).

The main objective of this research was to validate the parents' version of the Children's Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children's Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children's age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child's self-report in the framework of the multi-source assessment.

Effectiveness of Group vs. Individual Therapy to Decrease Peer Problems and Increase Prosociality in Children.

Emotional difficulties in children are often shown to be associated with peer problems and low prosocial behaviors. Super Skills for Life (SSL) is a transdiagnostic protocol for the prevention of emotional problems in children and has also obtained improvements of other comorbid symptoms. This study aimed at comparing the effects of SSL in reducing peer problems and increasing prosocial behaviors in children aged 8 to 12 years between the group and the individual modalities. For this purpose, 140 children (35% girls) received the program, 70 in group format and 70 in individual format, and were evaluated at the baseline, posttest, and after one year. Both modalities were effective in enhancing social relationships in children, although the individual modality showed more promising results. Children belonging to the individual modality group presented fewer peer problems (less social isolation and rejection, greater social acceptance, more friends) and greater prosocial behaviors (helping, empathy, kindness, and sharing) compared to children receiving the therapy in group modality, both in the short and in the long term. In conclusion, this study provides evidence of SSL protocol efficacy for improving children's peer relationships and prosocial behaviors and encourages the implementation of transdiagnostic interventions in both clinical and educational settings.

Separation Anxiety Assessment Scale-Parent Version: Spanish Validation (SAAS-P: Spanish Validation).

The objective of this research is to validate the Spanish adaptation of the Separation Anxiety Assessment Scale-Parent Version (SAAS-P). We conducted two studies with parents of schoolchildren aged 8-11 years: (1) exploratory factor analysis: 910 parents completed the Spanish version of the SAAS-P; (2) confirmatory factor analysis, reliability, and discriminant validity: 4127 parents completed the SAAS-P and 392 children were interviewed using the ADIS-IV. We identified four factors which explained 51.56% of the variance and these were confirmed by factor analysis. The internal consistency (α = 0.84) and the temporal stability (r = .75) of the four key symptom dimensions were good. The sensitivity of the scale was 90%, and its specificity, 82%. The additional subscales correlated closely with the four key symptom dimensions (r > .70), and predicted 81% and 57% of the cases with high symptom levels of separation anxiety. The results support the validity, reliability and clinical utility of the Spanish adaptation of the SAAS-P.

Necesidad de vaciamiento axilar en el cáncer de mama. Rigor en los métodos predictivos / Need for axillary lymph node dissection in breast cancer. Rigour in predictive methods

Introduccción: El objetivo es describir la validez diagnóstica y la seguridad de los métodos empleados en nuestro entorno para obviar el vaciamiento axilar en el tratamiento quirúrgico primario de mama en estadio inicial tras determinación de macrometástasis en el ganglio centinela. Métodos: Estudio observacional retrospectivo multicéntrico aprobado por el Comité de Ética. Determinación de sensibilidad, especificidad, valor predictivo positivo y negativo de los métodos: OSNA (punto de corte a 15.000 copias de ARN), score Tenon 5 (punto de corte en 5), perfil de alto riesgo (si no cumple T1G2RH+ HER-), criterios ACOSOG Z-11 y resultado de ganglio secundario. Se incluyó a pacientes con cáncer de mama dirigidas a tratamiento quirúrgico primario; tamaño T1-T2 y axila clínica y radiológicamente negativa; con resultado de ganglio centinela positivo para macrometástasis. Resultados: Se incluyó a 279 pacientes con macrometástasis en el ganglio centinela, de los cuales resultaron 69 (24,4%) linfadenectomías positivas. Los resultados de sensibilidad, especificidad, valor predictivo positivo y negativo fueron: OSNA (100%, 17%, 32%, 100%); Tenon 5 (91%, 34%, 31%, 92%); alto riesgo (82%, 32%, 28%, 85%), ACOSOG Z-11 (30%, 97%, 75%, 84%); ganglio secundario (86%, 76%, 55%, 94%). Conclusiones: El método más seguro, score Tenon 5, solo evitaría un tercio de linfadenectomías negativas. Un perfil de riesgo no ofrecería suficiente seguridad. La propuesta del grupo ACOSOG Z-11 sería el método menos seguro. La cuantificación de la macrometástasis por método OSNA no conseguiría validez diagnóstica. El análisis del ganglio secundario, siendo el método menos aplicado, sería el más válido, con mejor sensibilidad y especificidad conjunta. En nuestra valoración, ninguno de los métodos estudiados resultaría suficientemente riguroso pues no obtendrían resultados óptimos para permitir obviar la linfadenectomía

Introduction: The aim of this study was to describe the diagnostic validity and safety of the most commonly used methods to avoid axillary lymph node dissection (ALND) in the primary surgical treatment of initial-stage breast cancer after determination of sentinel node macrometastases. Methods: This multicenter, retrospective observational study was approved by the ethics committee and assessed the sensitivity, specificity, positive and negative predictive value of the following methods: OSNA (cut-off point of 15,000 RNA copies), Tenon 5 score (cut-off point 5), HIGH risk profile (RH+ HER-), ACOSOG Z-11 criteria and second-tier sentinel node outcome. We included patients with breast cancer undergoing primary surgical treatment, with T1-T2 tumours, clinically and radiologically negative axillae, and sentinel node macrometastases. Results: We included 279 patients, of whom 69 (24.4%) had a positive ALND. The results of sensitivity, specificity, positive predictive value and negative predictive value were as follows: OSNA (100%, 17%, 32%, 100%); Tenon 5 (91%, 34%, 31%, 92%); HIGH (82%, 32%, 28%, 85%), ACOSOG Z-11 (30%, 97%, 75%, 84%); SECOND (86%, 76%, 59%, 94%). Conclusions: The most accurate method, the Tenon score, would only avoid one-third of negative lymphadenectomies. Relying on a risk profile would not provide enough safety. The proposal of the ACOSOG Z-11 group was the least safe method. Quantification of macrometastases by OSNA would not be a valid diagnostic method. Second-tier sentinel node analysis, the least applied method, seems the most accurate, with the best sensitivity and specificity.In our analysis, none of the methods would be sufficiently rigorous to safely allow avoidance of ALND

Spanish Validation of the Separation Anxiety Assessment Scale.

The aim of this study was to investigate the factorial structure and psychometric properties of the Separation Anxiety Assessment Scale (SAAS) with Spanish schoolchildren. The participants in Study 1 were 1281 children aged 8-11. Exploratory factor analysis identified four factors: worry about calamitous events, fear of abandonment, fear of being alone, and fear of physical illness, which explained 47.77 % of the variance. The participants of Study 2 were 4628 schoolchildren aged 8-11. The four related factors model was validated by confirmatory factor analysis. The internal consistency (α = .84) and temporal stability (r = .77) were good. The convergent validity was evident from the pattern of correlations with the measures of separation anxiety, sensitivity to anxiety and school fears. The sensitivity of the scale was 83 %, and its specificity, 93 %. The complementary subscales predicted the diagnosis of separation anxiety disorder. The results support the reliability, validity and clinical utility of the SAAS.

Children's separation anxiety scale (CSAS): psychometric properties.

This study describes the psychometric properties of the Children's Separation Anxiety Scale (CSAS), which assesses separation anxiety symptoms in childhood. Participants in Study 1 were 1,908 schoolchildren aged between 8 and 11. Exploratory factor analysis identified four factors: worry about separation, distress from separation, opposition to separation, and calm at separation, which explained 46.91% of the variance. In Study 2, 6,016 children aged 8-11 participated. The factor model in Study 1 was validated by confirmatory factor analysis. The internal consistency (α = 0.82) and temporal stability (r = 0.83) of the instrument were good. The convergent and discriminant validity were evaluated by means of correlations with other measures of separation anxiety, childhood anxiety, depression and anger. Sensitivity of the scale was 85% and its specificity, 95%. The results support the reliability and validity of the CSAS.

Psychometric properties and factorial structure of the Spence Children's Anxiety Scale (SCAS) in Spanish adolescents.

The Spence Children's Anxiety Scale is an instrument widely applied in the assessment of the most common anxiety disorders in children and adolescents. This study examines its psychometric properties and the factorial structure in a large community sample of Spanish-speaking adolescents (N = 1,374) aged 13 to 17 years. The scale demonstrated strong internal consistency and good convergent and discriminant validity. Factor analysis confirmed the 6-factor original model, providing a good fit of the data for the Spanish sample. The good psychometric properties support its use by clinicians and researchers, adding evidence to the international empirical support for this measure.

Anxiety disorder symptoms in children and adolescents: differences by age and gender in a community sample.

INTRODUCTION: Anxiety symptoms in childhood and adolescence are an important risk factor for developing anxiety disorders in subsequent development stages. This study examines the frequency and characteristics of the symptoms of the principal anxiety disorders in children and adoloscents using a self-report questionnaire based on the diagnostic categories of the American Psychiatric Association (APA) manual. MATERIAL AND METHODS: A cross-sectional, non-interventional study was conducted on 2522 children and adolescents form 8 to 17 years (49% males), enrolled from different schools in the Province of Alicante who completed the Spence Children's Anxiety Scale. RESULTS: The mean score obtained on the scale (range: 0-114) was 25.15 (standard deviation (SD)=13.54). More than one in four (26.41%) of the children and adolescents showed high scores in any anxiety disorder. The anxiety symptoms due to separation were the most frequent in the sample (5.5%), followed by physical fears (5.1%). Girls scored significantly higher in all disorders (P<.001), except in obsessive-compulsive disorder. Differences were found as regards age in all disorders, except physical fears, but the effect sizes were only in anxiety due to separation, which decreased with age, and generalised anxiety, which was higher in adolescents than in children. CONCLUSIONS: From the mental health perspective, it is important to be able to detect anxiety symptoms in children from 8 years onwards, in order to intervene early and prevent the development of anxiety disorders in later life.

Spanish validation of the Spence Children's Anxiety Scale.

The purpose of this study was to investigate the factorial structure and psychometric properties of the Spence Children's Anxiety Scale (SCAS) in a sample of 1,708 Spanish children aged between 8 and 12 years. The SCAS was demonstrated to have satisfactory internal consistency with the Spanish sample, and factor analysis confirmed the six-factor original model. Convergent validity was supported by correlations with the State-Trait Anxiety Inventory for Children and the welfare dimension of the Child Health and Illness Profile-Children Edition. Low correlations between the SCAS and the Children's Depression Inventory supported the divergent validity. Analysis suggested that anxiety scores decrease with age, and girls reported higher scores than boys. Overall, the SCAS was shown to have good psychometric properties for use with Spanish children by clinicians and researchers.

Situaciones más temidas en la infancia tardía relacionadas con la ansiedad por separación y sus características en función de la edad y el sexo / Most feared situations related to separation anxiety and characteristics by age and gender in late childhood

En este artículo se analizan las situaciones más temidas relacionadas con la ansiedad por separación en una muestra de 1407 niños españoles con edades comprendidas entre 8 y 12 años, y se examinan las diferencias de la ansiedad por separación en función del sexo y la edad en la infancia tardía. Se utilizó una medida de autoinforme para el trastorno de ansiedad por separación, la Escala de Ansiedad por Separación Infantil, desarrollada para niños hispanohablantes y que está basada en los criterios diagnósticos del DSM-IV-TR y del CIE-10. Los resultados mostraron que los niños tienen más síntomas cognitivos que psicofisiológicos o motores. Las situaciones más temidas se relacionaban con la posibilidad de que algo malo les ocurriera a los padres y las menos comunes se relacionaban con las quejas somáticas. El 3.9% de la muestra manifestó síntomas de ansiedad por separación, más comunes en niñas que en niños y disminuyendo con la edad. Se discuten las implicaciones clínicas de estos y otros hallazgos (AU)

This article analyzes the most fear-provoking situations related to separation anxiety for a Spanish sample of 1407 children aged between eight and eleven, and examines gender and age differences in late child-hood. It was used a specific self-report measure for separation anxiety disorder, the Separation Anxiety Scale for Children, developed for Spanish-speaking children and based on the DSM-IV-TR and ICD-10 diagnostic criteria. Results showed that children have more cognitive symptoms than psychophysiological or motor responses. The most feared situations found are related to the possibility that something bad happen to the parents and the less common situations are those related to somatic complaints. Separation anxiety symptoms were experienced by 3.9% of the sample, were more common in girls than in boys and decreasing with age. The clinical implications of these and other findings are discussed (AU)

Modelo multidisciplinario de una unidad de diagnóstico rápido / Multidisciplinary model of an early diagnosis outpatients unit

No disponible

Avances en el tratamiento de las fobias específicas en la infancia y la adolescencia / Advances in the treatment of specific phobias in children and adolescents

Las fobias específicas son uno de los trastornos más frecuentes en la infancia y adolescencia. En las últimas décadas se han llevado a cabo numerosos estudios de caso único y estudios de grupo que muestran la utilidad de las técnicas psicológicas para reducir la conducta fóbica. Se han efectuado revisiones que clasifican los tratamientos según su eficacia probada, que nos permiten conocer el principio activo base de las intervenciones eficaces. El objetivo de este artículo es presentar el estado actual de los tratamientos para las fobias específicas en la infancia y la adolescencia. Se examinan las intervenciones llevadas a cabo tradicionalmente y se presentan terapias innovadoras que se desarrollan en la actualidad. Asimismo se plantea la necesidad de llevar a cabo estudios que cubran el vacío existente en determinadas áreas de la intervención (AU)

Specific phobias are among the most common disorders in childhood and adolescence. In the last decades there have been many studies that show the usefulness of psychological therapy to reduce phobic behavior. Reviews about the efficacy of single case and group treatments have been done, revealing the active principle of effective interventions. The goal of this article is to present the current status of treatments for specific phobias in children and adolescents. We examine both interventions carried out traditionally and innovative therapies that are being developed at present. We also emphasize the importance of further studies to fill the gaps in certain areas of intervention

Psychometric properties and diagnostic ability of the separation anxiety scale for children (SASC).

This research describes the psychometric properties of a new child self-report measure, the separation anxiety scale for children (SASC), which assesses the frequency of symptoms of separation anxiety in children from 8 to 11. The factor solution with a sample of 1,201 children from 8 to 11, isolated three factors, discomfort from separation, worry about separation, and calm at separation, tested by confirmatory factor analysis, which accounted for 32.80% of the total variance. Results indicated that the SASC has a high internal consistency (alpha = 0.83). The results revealed a high test-retest reliability of the instrument, and a high number of correctly diagnosed cases. The correlation of scores with other anxiety measures shows that the variable most associated with separation anxiety is trait-anxiety.

Muerte digna o ensañamiento terapéutico: una reflexión para profesionales de la salud / Dignified death or therapeutical cruelty: A reflexion for healthcare professionals

El acompañamiento durante el sufrimiento humano se vuelve un desafío a la reflexión bioética, debido a una avanzada edad, a la gravedad de la enfermedad, a la condición terminal y al abandono familiar de pacientes en estas situaciones, y por tanto al dilema de la utilidad de algunos procedimientos y la consecuente actitud del profesional de enfermería. Centro de estos problemas es la concientización de los cuidados de enfermería y la relación enfermera-paciente en una situación de enfermedad terminal (SET) Se trata de un Estudio de caso producto de la práctica de los alumnos de la especialidad de post grado en Enfermería del Adulto en estado Crítico aplicando el Proceso de Atención de Enfermería basado en las 14 necesidades de Virginia Henderson realizado a una persona portadora de Cor Pulmonale. Su objetivo es analizar la evolución clínica de la información registrada siguiendo la metodología de estudio de casos. El marco teórico y el posterior análisis está centrado en la utilización de los conceptos ensañamiento terapéutico y rol de enfermería en el marco que proporciona la reflexión bioética contemporánea sobre el derecho a una muerte digna.

The company or accompany during human suffering becomes a challenge to bioethics reflection, due a very old age, the illness severity, a terminal condition, and the family abandon of patients in these situations, and therefore, also for the dilemma of the usefulness of some procedures and the consequent attitude of the nursing professional. The core of these problems is the conscious of nursing care and the nurse-patient relationship within a terminal illness situation (SET). This is a case study product of the practice of nursing specialized on critical state adults students, applying the Nursing. Attention Process based on the Virginia Henderson's 14 needs on a person carrying the Cor Pulmonale. The object to be analyzed is the clinical evolution of information registered following the case study methodology. The theoretical frame and later analysis is centered on the use of therapeutically enragement concepts and the nursing role in the frame that gives the contemporaneous bioethical reflection about the right to a honorable death.

Eficacia diferencial de los tratamientos psicológicos en la fobia a los animales: un estudio meta-analítico / Differential efficacy of the psychological treatments for animal phobia: a meta-analytic study

Se realizó un metaanálisis sobre la eficacia del tratamiento psicológico para la fobia a los animales en población infantil y adolescente. Se localizaron 9 investigaciones que dieron lugar a 26 estudios independientes, 20 de grupos de tratamiento y 6 de grupos de control. Participaron en el metaanálisis 362 niños de aproximadamente 8 años de edad media, con predominio del género femenino (68,57%). La eficacia de los tratamientos fue muy elevada (d+= 2,80), consiguiendo los mayores logros terapéuticos la técnica de modelado (d+= 3,02). Cuando la terapia era breve e intensiva, se desarrollaba en un entorno natural bajo la supervisión del terapeuta, y los estímulos temidos eran las serpientes, perros o gatos, se alcanzaron los mejores resultados. El tratamiento fue más eficaz en los niños de menor edad y de género masculino. Se discuten las implicaciones clínicas de estos hallazgos

A meta-analysis was performed on the effectiveness of psychological treatment for animal phobia in childhood and adolescence. Nine scientific reports were identified and led to 26 independent studies, 20 treatment groups and 6 control groups. Three hundred and sixty-two children, with an average age of 8 and predominantly girls (68.57%), took part. The psychological treatment was highly effective (d+= 2.80) and the more effective procedure was modelling (d+= 3.02). Results were better when therapy was brief and intensive, it was performed in a natural environment, and the feared animals were snakes, dogs and cats. Response to treatment was better in the youngest children and in boys. The clinical implications of these findings are discussed

Adolescencia: consumo de alcohol y otras drogas / Adolescence: consumption of alcohol and other drugs

El consumo de alcohol y otras drogas entre los adolescentes suscita preocupación social. Por un lado, ciertas características de este período evolutivo pueden facilitar el consumo de alcohol y otras drogas. Por otro, el consumo de estas sustancias suele iniciarse en esta etapa de la vida. En este artículo se analizan las tendencias actuales del consumo de alcohol y otras drogas en la adolescencia. Se discuten los problemas derivados del abuso de alcohol que afectan de forma especial a los adolescentes. Se revisan los factores de riesgo del consumo abusivo, exponiendo un modelo integrador. Se concluye con una propuesta de intervención para ser aplicada en contextos educativos, el programa Saluda al fin de semana, un currículo preventivo dirigido a estudiantes de enseñanza secundaria obligatoria (AU)

¿Exito o fracaso de la prevención del abuso de drogas en el contexto escolar? Un meta-análisis de los programas en España / Success or failure of drug abuse prevention in the school environment? A meta-analysis of the programs in Spain

Se presentan los resultados de un meta-análisis sobre la eficacia de los programas para prevenir el abuso de drogas, aplicados en el contexto escolar en España. Se identificaron 21 estudios independientes que cumplieron los criterios de selección, procedentes de 12 informes de investigación realizados entre 1985 y 2002. El tamaño del efecto medio global reveló que los programas en el contexto escolar para disminuir el abuso de drogas son eficaces, aunque su eficacia es pequeña (d+ = 0,20). Sin embargo, si se analizan los programas que presentan resultados de seguimiento a medio plazo (rango: 6-18 meses), entonces la eficacia aumenta hasta alcanzar un nivel moderado (d+= 0,65). Los programas resultaron más eficaces con el alcohol, que con el tabaco u otras drogas. También obtuvieron más éxito para disminuir el consumo y mejorar el conocimiento, que para modificar las actitudes hacia las drogas. El componente de los programas que se mostró más eficaz fue la información sobre las sustancias. Se discuten estos hallazgos y se señalan sugerencias para futuras investigaciones (AU)

Tratamiento psicológico de la depresión infantil y adolescente: ¿evidencia o promesa? / The psychological treatment of childhood and adolescent depression: evidence or promise?

Se presentan los resultados de un meta-análisis sobre la eficacia del tratamiento psicológico de la depresión infantil y adolescente. Se localizaron 15 ensayos controlados en el período 1980-2002, que dieron lugar a 24 estudios independientes. Se reclutaron 863 participantes, rango de edad 7-19 años, con predominio de adolescentes mujeres. El tratamiento más utilizado fue la terapia cognitivo-conductual (80 por ciento), el único aplicado en depresión infantil, mientras que en depresión adolescente se empleó también terapia interpersonal y terapia familiar sistémica. Globalmente la eficacia del tratamiento psicológico resultó media (d. = 0,53). La respuesta al tratamiento fue similar en la depresión infantil y en la adolescente, aunque las muestras escolares mejoraron más que las clínicas. Se constató el mantenimiento de la ganancia terapéutica, obteniéndose un tamaño del efecto de 0,50 en el seguimiento, con un intervalo promedio de siete meses. El tratamiento también produjo una ligera mejora de la autoestima (d+ = 0,37). Se discuten las implicaciones clínicas de estos hallazgos (AU)